By Richard P. Holm, MD
 
Of the 40 million people with hearing loss in the U.S., 25 percent of those, or 10 million, have lost their hearing as a result of exposure to excessive noise. But how much noise is too much?
 
Measured as decibels (dB), the acceptable manufacturing noise standard is to allow a daily exposure up to but not over 85 dB in an eight-hour period. More than that can cause permanent injury to our hearing. This is likely due to wear and tear on the tiny hairs that vibrate when sound is introduced. It’s like a line of kids walking across one path on the grass day after day. A little is good, too much kills the grass.
 
The average conversation, for example, is usually around 50-60 dB, street noises at 70-80, and an operating lawnmower at about 90. Noise levels above 90 come from surprising places like screaming babies, convertibles driving at 60 mph, marching bands, leaf blowers, hand and hair driers, and those noisy electronically amplified concerts. Single loud sounds like gunfire at about 150 dB can also be damaging, but the time exposed to lower volumes are the most significant and unrecognized danger we face daily.
 
A recent social trend has created a new threat. Tuning out the world with ear buds, while turning up the tunes for hours, can be like riding on the two-cylinder John Deere tractor with no cab all day while cultivating corn. Those old two-cylinders were loud, and so it can be with ear buds! Ear bud volumes at 100 dB for as short as 15 minutes can damage hearing. Again, it’s the volume multiplied by time that makes it so bad. One study showed that 97 percent of third graders had documented exposure to hazardous sound levels. Another showed that 12.5 percent of 6 to 19-year-olds in the U.S. already had hearing loss directly attributed to noise exposure.
 
What’s more, if the volume is too loud, ear buds can be even more dangerous as they may prevent us from hearing the noises that help us avoid danger. For example, walkers, runners, and bicyclists need their ears to hear when a truck might be coming from behind.
 
Of course, it isn’t just noise that can reduce our hearing. Infections, trauma, and even medications like antibiotics, chemotherapy drugs, or pain medications can do it too. Seek medical help if you notice your hearing is changing.
 
The bottom line: Protect your ears by avoiding exposure to too much noise, get help if your hearing changes and beware of ear bud risks.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.                

By Richard P. Holm, MD
 
A muddle and mixture of family and friends surrounded the dying elderly woman like she was a campfire. They came to honor and pay their respects; many generations, from all over the country. This group seemed well educated, well-read, and the intellectual discussions were tossed around in that room like a basketball. She had said, to all, that it was time. “Please stop the dialysis,” she insisted, and, it was stopped. At first, she was almost holding court, but over the days, as she was slipping across to the other side, the hymns started filling the room, spilling out into the hospital halls, helping to carry her home. Tears of sadness, appreciation, joy and family love flowed freely the night she died.
 
Hers was a story about language, literature, ethics, music and spirit. Take away language and literature, and the appreciation she deserved for years of pushing for education and learning for her family and friends would have passed without notice. Take away ethics, and the patient wouldn’t have known she could stop dialysis. Take away music and spiritual energy, and the family wouldn’t have grasped the true depth and value of the woman or the connection and love they shared with her and each other. The humanities give us meaning, but, from where and why did they begin?
 
There is no record or hard evidence as to how or when Homo sapiens began speaking, but there are plenty of theories. The one I like the most asserts that, at first, we sang and drummed descriptive sounds while pantomiming hunting stories around the campfire until, over hundreds and thousands of years, words and lyrics evolved. Much later, words became literature when written down in a retrievable way, first on clay tablets, then, on papyrus, parchment, paper and, now, computers.
 
More than one linguistic expert has theorized that it was language which facilitated the Homo sapiens species to grow and dominate. When ethical words about a common virtue, or rule, convinced, inspired and unified large collections of tribes, these ancient groups became empowered. Words from The Golden Rule, “Do unto others as you would have them do unto you,” or the Code of Hammurabi, “A bag of barley is worth two shekels of silver,” and even song lyrics like, “Kyrie eleison (Lord, have mercy),” have pushed civilization forward.
 
The history of humanity has been made bright by language, literature, ethics, music and spirit. Also bright was that room with the elderly dying patient and her loving and singing family and friends.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.                

By Richard P. Holm, MD
 
If you don't use it, you'll lose it. I bet I've heard and repeated this age-old aphorism a million times. But can it be over-used?
 
The adage about using it certainly fits when trying to enhance wellness for all sorts of medical systems: working the brain with puzzles and conversation helps ward off memory loss; walking fast enough to cause one to huff and puff, keeps the heart and lungs strong; regular sexual activity helps prevent impotence; filling the gut with a high fiber diet keeps the bowels in shape and makes you a regular sort-a-guy.
 
But what can you do when it hurts to move those old joints? Should you rest or should you exercise a joint with degenerative osteoarthritis? Experts say this depends on the state of that arthritis. If it is a hot and inflamed joint, it's better to address it first with expert advice, medication and time and not to force a lot of movement until later when it is cooled down. If, however, it is the cool-yet-stiff type of arthritis, then that’s a different story.
 
I always go back to a famous study that involved older people with very bad osteoarthritic knees, the kind that the orthopedic surgeon would call bone-on-bone. Scientists divided these arthritic patients into two groups. The first group continued their sedentary habits and the second group was pushed to regularly walk, stretch, and move on those worn out knees. Which group do you think did better? You guessed it, the members of the exercise group rated themselves to be in less overall pain, were better able to stay mobile and considered themselves happier in general than the sedentary group. One physician friend advised me once that, “Motion is the lotion for keeping those stiff joints moving.”
 
The American College of Rheumatology gives us the following recommendations:

• Though some of the joint changes of osteoarthritis are irreversible and sometimes surgery is required to get a severely arthritic person moving again, most patients will not need joint replacement surgery;
• Keep in mind that symptoms of osteoarthritis can vary greatly among those affected;
• Exercise is an important part of what we do to decrease joint pain and increase function.

 
So, say it again to yourself every morning while looking at the person in that mirror: "Use it or lose it."
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.                

​By Richard P. Holm, MD
 
The elderly patient came back to our rural hospital from a hospital in a nearby larger city after having had major surgery and feeding-tube placement. The care from the bigger hospital was superb except that the patient was getting too much nutrient and fluids and was a bit “overloaded.” Also, the family was concerned that perhaps they had been too aggressive in getting stressful surgery for their elderly mom, whose memory had begun to slip. As her physician, I cut back on the feeding-tube supplements, stopped the intravenous fluids, provided a little diuretic and did labs and X-ray for dementia. I took plenty of time with family and patient learning about their wishes should our patient again deteriorate. All agreed to emphasize comfort from here on out, and if she started to fail, we would do our best in her home hospital and not transfer her care again.
 
I had been that patient’s primary care doc for years. Practicing outpatient and inpatient care in a smaller town gave me the experience to see what was happening. The patient and family knew me, trusted me and appreciated the time I spent listening to her. Quality care reviewers, government oversight people and insurance companies also know the value of a well-trained rural primary care provider who not only understands how to care for complex patients, but also, knows when and where to refer when specialized care is needed. In fact, experts believe an ideal system would define a primary care provider for every person.
 
Unfortunately, there are not enough rural primary care docs. Many speculate as to why this is; however, I believe the need has resulted from misinformed med students and residents who think the lifestyle in rural America is not satisfying enough. In the July 2019 issue of South Dakota Medicine, a survey of family physicians practicing in this state found much lower burnout rates in family docs practicing in rural areas (25 percent) compared with those practicing in larger metropolitan areas (51 percent). Evidently, some social aspects of rural practice seem to confer a protective effect against burnout. This new data should be helpful when young physicians are looking for the most satisfying places to practice.
 
My elderly patient went home in about a week, happy with our community hospital and the care she received. Her doctor was also pleased, as he had the reward of successful care, the honor of satisfied family and the joy of truly helping someone while practicing in a rural setting.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.